Provider Demographics
NPI:1003628652
Name:OLISA-ALEXANDER, VIVIAN (LPC-A)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:OLISA-ALEXANDER
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 TIDE ROCK LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1870
Mailing Address - Country:US
Mailing Address - Phone:832-691-7301
Mailing Address - Fax:
Practice Address - Street 1:11200 BROADWAY ST STE 2743
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9787
Practice Address - Country:US
Practice Address - Phone:281-957-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional